The rapid spread of the coronavirus has sparked worldwide alarm. The World Health Organisation (WHO) has declared this rapidly spreading outbreak a pandemic. Many countries are struggling with a rise in confirmed cases. All over the world people are advised to be prepared for disruptions to daily life, causing stress to individuals, families and communities. Our fears arise from a misaligned ratio of stress to resiliency. The more resilient we become the less stress we will feel. But this is a subject that I will be expanding on further in my future posts.
Here's an edited version of a recent Harvard Medical School article on the subject.
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Can vitamin C be used to treat patients with COVID-19?
Some critically ill patients with COVID-19 have been treated with high doses of intravenous (IV) vitamin C in the hope that it will hasten recovery. However, there is no clear or convincing scientific evidence that it works for COVID-19 infections, and it is not a standard part of treatment for this new infection. A study is underway in China to determine if this treatment is useful for patients with severe COVID-19; results are expected in the fall.
The idea that high-dose IV vitamin C might help in overwhelming infections is not new. A 2017 study found that high-dose IV vitamin C treatment (along with thiamine and corticosteroids) appeared to prevent deaths among people with sepsis, a form of overwhelming infection causing dangerously low blood pressure and organ failure. Another study published last year assessed the effect of high-dose vitamin C infusions among patients with severe infections who had sepsis and acute respiratory distress syndrome (ARDS), in which the lungs fill with fluid. While the study's main measures of improvement did not improve within the first four days of vitamin C therapy, there was a lower death rate at 28 days among treated patients. Though neither of these studies looked at vitamin C use in patients with COVID-19, the vitamin therapy was specifically given for sepsis and ARDS, and these are the most common conditions leading to intensive care unit admission, ventilator support, or death among those with severe COVID-19 infections.
Regarding prevention, there is no evidence that taking vitamin C will help prevent infection with the coronavirus that causes COVID-19. While standard doses of vitamin C are generally harmless, high doses can cause a number of side effects, including nausea, cramps, and an increased risk of kidney stones.
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Is the antiviral drug Remdesivir effective for treating COVID-19?
Scientists all over the world are testing whether drugs previously developed to treat other viral infections might also be effective against the new coronavirus that causes COVID-19.
One drug that has received a lot of attention is the antiviral drug Remdesivir. That's because the coronavirus that causes COVID-19 is similar to the coronaviruses that caused the diseases SARS and MERS — and evidence from laboratory and animal studies suggests that Remdesivir may help limit the reproduction and spread of these viruses in the body. In particular, there is a critical part of all three viruses that can be targeted by drugs. That critical part, which makes an important enzyme that the virus needs to reproduce, is virtually identical in all three coronaviruses; drugs like Remdesivir that successfully hit that target in the viruses that cause SARS and MERS are likely to work against the COVID-19 virus.
Remdesivir was developed to treat several other severe viral diseases, including the disease caused by Ebola virus (not a coronavirus). It works by inhibiting the ability of the coronavirus to reproduce and make copies of itself: if it can't reproduce, it can't make copies that spread and infect other cells and other parts of the body.
Remdesivir inhibited the ability of the coronaviruses that cause SARS and MERS to infect cells in a laboratory dish. The drug also was effective in treating these coronaviruses in animals: there was a reduction in the amount of virus in the body, and also an improvement in lung disease caused by the virus.
The drug appears to be effective in the laboratory dish, in protecting cells against infection by the COVID virus (as is true of the SARS and MERS coronaviruses), but more studies are underway to confirm that this is true.
Remdesivir was used in the first case of COVID-19 that occurred in Washington state, in January 2020. The patient was severely ill, but survived. Of course, experience in one patient does not prove the drug is effective.
Two large randomised clinical trials are underway in China. The two trials will enrol over 700 patients and are likely to definitively answer the question of whether the drug is effective in treating COVID-19. The results of those studies are expected in April or May 2020. Studies also are underway in the United States, including at several Harvard-affiliated hospitals. It is hard to predict when the drug could be approved for use and produced in large amounts, assuming the clinical trials indicate that it is effective and safe.
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Is a lost sense of smell a symptom of COVID-19? What should I do if I lose my sense of smell?
Increasing evidence suggests that a lost sense of smell, known medically as anosmia, may be a symptom of COVID-19. This is not surprising, because viral infections are a leading cause of loss of sense of smell, and COVID-19 is caused by a virus. Still, loss of smell might help doctors identify people who do not have other symptoms, but who might be infected with the COVID-19 virus — and who might be unwittingly infecting others.
A statement written by a group of ear, nose and throat specialists (otolaryngologists) in the United Kingdom reported that in Germany, two out of three confirmed COVID-19 cases had a loss of sense of smell; in South Korea, 30% of people with mild symptoms who tested positive for COVID-19 reported anosmia as their main symptom.
On March 22nd, the American Academy of Otolaryngology-Head and Neck Surgery recommended that anosmia be added to the list of COVID-19 symptoms used to screen people for possible testing or self-isolation.
In addition to COVID-19, loss of smell can also result from allergies as well as other viruses, including rhinoviruses that cause the common cold. So anosmia alone does not mean you have COVID-19. Studies are being done to get more definitive answers about how common anosmia is in people with COVID-19, at what point after infection loss of smell occurs, and how to distinguish loss of smell caused by COVID-19 from loss of smell caused by allergies, other viruses, or other causes altogether.
Until we know more, tell your doctor right away if you find yourself newly unable to smell. He or she may prompt you to get tested and to self-isolate.
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Are Chloroquine and Hydroxychloroquine effective for treating COVID-19?
Recently, there has been considerable discussion of whether two related drugs — I and Hydroxychloroquine — that have been available for decades to treat other illnesses might also be effective in treating COVID-19.
The drugs are primarily used to treat malaria and several inflammatory diseases, including systemic Lupus Erythematous (lupus) and rheumatoid arthritis. No drug is perfectly safe, but these drugs are quite safe when used for just the several days they might be needed to treat COVID-19. They are also cheap, already available at our local drug stores, and relatively free of side effects.
The question, of course, is whether they are effective against the coronavirus that causes COVID-19. Are they effective in killing the virus in a laboratory dish? And are they effective in killing the virus in people? If the answer to the first question is "no," there's no point in getting an answer to the second question.
There is strong evidence that both drugs kill the COVID-19 virus in the laboratory dish. The drugs appear to work through two mechanisms. First, they make it harder for the virus to attach itself to the cell, inhibiting the virus from entering the cell and multiplying within it. Second, if the virus does manage to get inside the cell, the drugs kill it before it can multiply.
But do the drugs work in people with COVID-19? Many studies are underway to get an answer to this question, but as of March 24, 2020, only two have issued preliminary results.
One report, published in February 2020, claimed that Chloroquine had been used in more than 100 patients in China who had COVID-19. The scientists stated that their results demonstrated that Chloroquine is superior to the control treatment in inhibiting the worsening of pneumonia, improving lung imaging findings, eliminating the virus from the body, and shortening the duration of the disease.
These claims are exciting. However, the report provided virtually no evidence in support of the claims. First of all, this was not a randomised, double-blind controlled trial, the gold standard for research studies. Second, no evidence was presented as to how severe the pneumonia was, nor whether findings on lung x-rays or CT scans really improved. Third, although they claim the drug made the virus disappear, they didn't report what the levels of the virus were before versus after the treatment. In short, not much evidence.
Another small study was conducted by a group of scientists in southern France, a region hard hit by COVID-19. This, also, was not a randomised trial. Instead, the scientists compared 26 patients who received Hydroxychloroquine to 16 who did not: after six days, the virus was gone from the body in 70% of those given the treatment, compared to only 12.5% of those who weren't. The drug appeared to be as effective in the sickest patients as in the least sick, but the study was too small to be sure about that. The study also was too small to say that people who received the treatment were protected against a prolonged illness or death.
There are many studies underway, and we should have more solid answers within a few months.
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I heard that certain blood pressure medicines might worsen symptoms of COVID-19.
Should I stop taking my medication now just in case I do get infected?
Should I stop if I develop symptoms of COVID-19?
You are referring to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), two types of medications used primarily to treat high blood pressure (hypertension) and heart disease. Doctors also prescribe these medicines for people who have protein in their urine, a common problem in people with diabetes. At this time, the American Heart Association (AHA), the American College of Cardiology (ACC), and the Heart Failure Society of America (HFSA) strongly recommend that people taking these medications should continue to do so, even if they become infected. Here's how this concern got started. Researchers doing animal studies on a different coronavirus (the SARS coronavirus from the early 2000s) found that certain sites on lung cells called ACE-2 receptors appeared to help the SARS virus enter the lungs and cause pneumonia. ACE inhibitor and ARB drugs raised ACE-2 receptor levels in the animals.
Could this mean people taking these drugs are more susceptible to COVID-19 infection and are more likely to get pneumonia?
The reality today:
Human studies have not confirmed the findings in animal studies.
Some studies suggest that ACE inhibitors and ARBs may reduce lung injury in people with other viral pneumonias. The same might be true of pneumonia caused by the COVID-19 virus.
Stopping your ACE inhibitor or ARB could actually put you at greater risk of complications from the infection, since it's likely that your blood pressure will rise and heart problems would get worse.
The bottom line: The AHA, ACC, and HFSA strongly recommend continuing to take ACE inhibitor or ARB medications, even if you get sick with COVID-19.
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Should I go to the doctor or dentist for non-urgent appointments?
During this period of social distancing, it is best to postpone non-urgent appointments with your doctor or dentist. These may include regular good visits or dental cleanings, as well as follow-up appointments to manage chronic conditions if your health has been relatively stable in the recent past. You should also postpone routine screening tests, such as a mammogram or PSA blood test if you are at average risk of disease. Many doctor's surgeries have started restricting surgery visits to urgent matters only, so you may not have a choice in the matter.
As an alternative, doctor's offices are increasingly the so-called telehealth services. This may mean appointments by phone call, or virtual visits using a video chat service. Ask to schedule a telehealth appointment with your doctor for a new or ongoing non-urgent matter. If, after speaking to you, your doctor would like to see you in person, he or she will let you know.
What if your appointments are not urgent but also don't fall into the low-risk category? For example, if you have been advised to have periodic scans after cancer remission, if your doctor sees you regularly to monitor for a condition for which you're at increased risk, or if your treatment varies based on your most recent test results? In these and similar cases, call your doctor for advice.
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Is it safe to take Ibuprofen to treat symptoms of COVID-19?
Some French doctors advise against using ibuprofen (Motrin, Advil, many generic versions) for COVID-19 symptoms based on reports of otherwise healthy people with confirmed COVID-19 who were taking an NSAID for symptom relief and developed a severe illness, especially pneumonia. These are only observations and not based on scientific studies.
The WHO initially recommended using paracetamol instead of ibuprofen to help reduce fever and aches and pains related to this coronavirus infection, but now states that either paracetamol or ibuprofen can be used. Rapid changes in recommendations create uncertainty. Since some doctors remain concerned about NSAIDs, it still seems prudent to choose paracetamol first, with a total dose not exceeding 3,000 milligrams per day.
However, if you suspect or know you have COVID-19 and cannot take paracetamol, or have taken the maximum dose and still need symptom relief, taking over-the-counter ibuprofen does not need to be specifically avoided.
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How reliable is the test for COVID-19?
Tests are becoming more widely available and are being processed in commercial labs and academic centres across the country. In the US, the most common test for the COVID-19 virus looks for viral RNA in a sample taken with a swab from a person's nose or throat. Currently, you can expect the test results within three to four days. Likely the turnaround time for results will be shorter over the next few weeks. If a test result comes back positive, it is almost certain that the person is infected. A negative test result is less definite. An infected person could get a so-called "false negative" test result if the swab missed the virus, for example, or because of an inadequacy of the test itself. We also don't yet know at what point during the course of illness a test becomes positive.
If you experience COVID-like symptoms and get a negative test result, there is no reason to repeat the test unless your symptoms get worse. If your symptoms do worsen, call your doctor or local or state healthcare department for guidance on further testing. You should also self-isolate at home. Wear a mask if you have one when interacting with members of your household. And practice social distancing.
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